Oral Cancer

Overview

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Oral cancer is a significant health concern that often starts as a small sore or lesion in the mouth that does not heal. The cancer can develop in various parts of the oral cavity and may spread to nearby tissues or lymph nodes. It is part of a broader category of cancers known as oral squamous cell carcinoma (OSCC), which is the most common form.

The cancer can develop in various parts of the oral cavity and may spread to nearby tissues or lymph nodes. It is part of a broader category of cancers known as oral squamous cell carcinoma (OSCC), which is the most common form.

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Symptoms
  • Persistent Sores or Ulcers: Non-healing sores or ulcers in the mouth.
  • White or Red Patches: White (leukoplakia) or red (erythroplakia) patches in the mouth.
  • Pain: Persistent pain or discomfort in the mouth or throat.
  • Swelling: Unexplained swelling or lumps in the mouth, neck, or jaw.
  • Bleeding: Unexplained bleeding from the mouth or gums.
  • Difficulty Swallowing: Pain or difficulty swallowing food or liquids.
  • Change in Voice: Hoarseness or changes in the voice.
  • Loose Teeth: Teeth that become loose without any obvious reason.
  • Ear Pain: Pain in the ear, often associated with oral symptoms.
Complications
  • Metastasis: Spread of cancer to other parts of the body, including the lymph nodes, lungs, and other organs.
  • Local Recurrence: Cancer returning in the same area after treatment.
  • Difficulty Eating and Speaking: Impact on quality of life due to pain and functional difficulties.
  • Disfigurement: Surgical treatment may result in changes to appearance and require reconstructive surgery.
  • Infections: Risk of infection due to compromised oral tissues or post-surgical wounds.
  • Nutritional Deficiencies: Difficulty eating can lead to poor nutrition and weight loss.
Causes
  • Tobacco Use: Smoking cigarettes, cigars, or pipes, and using smokeless tobacco (chewing tobacco or snuff) are major risk factors.
  • Alcohol Consumption: Excessive and prolonged alcohol use increases the risk of oral cancer.
  • Human Papillomavirus (HPV): Certain strains of HPV, particularly HPV-16, are associated with oral cancers.
  • Chewing Betel Nuts: Common in some cultures, betel nut chewing is linked to oral cancer.
  • Sun Exposure: Excessive sun exposure, particularly to the lips, can increase the risk of lip cancer.
  • Poor Oral Hygiene: Chronic irritation from poor dental hygiene and ill-fitting dentures may contribute to the risk.
Prevention
  • Avoid Tobacco and Alcohol: Reducing or eliminating tobacco and excessive alcohol consumption significantly lowers the risk.
  • HPV Vaccination: Vaccination against HPV can reduce the risk of HPV-related oral cancers.
  • Protective Measures: Use lip balm with sun protection to reduce the risk of lip cancer from sun exposure.
  • Healthy Diet: Eating a balanced diet rich in fruits and vegetables may help lower risk.
  • Regular Dental Check-ups: Regular dental visits can help in early detection of abnormalities.
  • Good Oral Hygiene: Maintaining proper oral hygiene can prevent chronic irritation and infections.
Risk Factors
  • Age: Risk increases with age, particularly in individuals over 50.
  • Gender: Men are more likely than women to develop oral cancer.
  • Ethnicity: Oral cancer is more common in certain ethnic groups, including those with a higher prevalence of tobacco and alcohol use.
  • Pre-existing Conditions: Conditions such as oral leukoplakia or erythroplakia increase the risk of developing oral cancer.
  • Family History: A family history of cancer may increase susceptibility.
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How is it treated?

Surgery:

  • Tumor Resection: Removal of the tumor and surrounding tissues. In advanced cases, reconstructive surgery may be required.
  • Neck Dissection: Removal of affected lymph nodes if the cancer has spread.

Radiation Therapy:

  • External Beam Radiation: Targeted radiation to kill cancer cells and shrink tumors.
  • Brachytherapy: Placement of radioactive sources near or within the tumor.

Chemotherapy:

  • Systemic Treatment: Use of drugs to kill cancer cells throughout the body, often used in combination with radiation or surgery.

Targeted Therapy:

  • Drugs that Target Specific Molecules: Treatment that targets specific pathways involved in cancer growth.

Immunotherapy:

  • Enhancing the Body's Immune System: Use of drugs to help the immune system recognize and attack cancer cells.

Palliative Care:

  • Symptom Management: Providing relief from symptoms and improving quality of life for patients with advanced cancer.
  • Early diagnosis and treatment are crucial for improving outcomes in oral cancer. Regular screening and attention to any persistent or unusual oral symptoms are important for early detection and intervention.

How is it Diagnosed?

Oral cancer is typically diagnosed through a combination of clinical examination, imaging, and tissue biopsy. The diagnostic process begins with a detailed medical and dental history, including risk factors such as tobacco use, alcohol consumption, HPV infection, and family history. A physical examination is performed to inspect the mouth, tongue, gums, floor of the mouth, and throat for abnormal lesions, ulcers, or growths that do not heal.

Suspicious areas may be subjected to a biopsy, which is the gold standard for confirming oral cancer. This may involve an incisional biopsy or a fine-needle aspiration (FNA), particularly if lymph nodes are involved. Brush biopsy (cytology) may be used for initial screening but is not definitive.

Imaging studies help determine the extent and spread of cancer. These include CT (computed tomography) scans, MRI (magnetic resonance imaging), and PET (positron emission tomography) scans. Panoramic X-rays and intraoral radiographs are also used to evaluate involvement of jaw bones.

In advanced cases, endoscopy may be employed to assess the oropharynx and larynx. TNM staging (Tumor, Node, Metastasis) guides treatment planning. Early detection greatly improves the prognosis, which is why regular dental check-ups are crucial, especially for individuals in high-risk groups.

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